Behavioral Health Medication Poisoning

What is behavioral health medication poisoning?

Behavioral health medications are used in animals and humans. They include antidepressants, atypical antidepressants, antipsychotics, and amphetamines.

Dogs and cats often require lower doses of these medications than humans and are more sensitive to overdoses. For that reason, if a dog or cat ingests a human dose of these medications or accesses a bottle of their own medication, behavioral health medication poisoning can occur.

• Antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). Antidepressants are medications that affect the use and re-uptake of two neurotransmitters in the brain: serotonin and norepinephrine.
• Atypical antidepressants also affect levels and function of neurotransmitters in the brain. There are many medications in this class, and they work in a variety of ways.
• Antipsychotics are medications used to control psychosis and some signs of dementia. They work by blocking or affecting levels of various brain chemicals and transmitters, such as dopamine, serotonin, noradrenaline, and glutamate.
• Amphetamine stimulant-type medications are often used to treat human attention deficit hyperactivity disorder (ADHD) and a few other conditions. There are many formulations, including amphetamine, dextroamphetamine, lisdexamfetamine, and mixed amphetamine salts. These medications have stimulant properties that work in the central nervous system and brain, but also affect the cardiovascular system and gastrointestinal (GI) tract.

Though some of these medications are used therapeutically in dogs and cats for anxiety, aggression, compulsive behaviors, inappropriate urination, certain phobias, and other behavioral abnormalities, they can cause side effects, even at therapeutic or low doses.

As these are all prescription medications, not available over the counter, poisoning from these medications most often occurs when a dog or cat gets into their own or their owner’s medication.

What are the signs of behavioral health medication poisoning?

Signs of behavioral health medication poisoning can occur within minutes or can take up to four to six hours to begin. Signs typically involve the GI tract, cardiovascular system, or central nervous system. GI upset, especially drooling, can occur early after ingestion. Signs can progress to abnormal heart rate or rhythm, tremors, seizures, agitation, fever, and decreased alertness. Behavioral changes, such as agitation, disorientation, drowsiness, or aggression, can be seen.

Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin stimulation in the nervous system, which is common in overdoses of many behavioral health medications. Serotonin syndrome can present with any or all the above signs, though fever, disorientation, and vocalization are especially common.

If you suspect your pet has ingested a behavioral health medication that was not prescribed to them or that was above their prescribed dose, immediately call your veterinarian or Pet Poison Helpline, a 24/7 animal poison center, at 1-800-213-6680.

How is behavioral health medication poisoning diagnosed?

Behavioral health medication poisoning is diagnosed by a combination of clinical signs, physical exam findings, and history of possible or confirmed exposure. For this reason, the veterinarian often asks what medications may have been present in the pet’s environment. If necessary, blood testing can be submitted to an outside lab to test for levels of a specific medication, but results can take several days or more to return.

How is behavioral health medication poisoning treated?

If your pet ingests a potentially toxic dose of behavioral health medication, your veterinarian may recommend decontamination, which may include inducing vomiting and administering medical-grade activated charcoal. If signs of poisoning are already present, decontamination may no longer be recommended due to safety concerns.

Treatment for signs of behavioral health medication poisoning is specific to the clinical signs present. Hospitalized care is typically required if signs of poisoning are present or expected. Frequent monitoring of heart rate, blood pressure, body temperature, and agitation or sedation level is often required.

Treatments may include:

• Anti-nausea medication
• Intravenous fluids
• Sedation
• Medications to control heart rate and blood pressure
• Medication for tremors
• Anticonvulsants (anti-seizure medication)
• Medication to control serotonin syndrome

Even with early and appropriate treatment, signs of behavioral health medication poisoning can be severe and sometimes life-threatening.

What is the prognosis for behavioral health medication poisoning?

The prognosis for recovery from behavioral health medication poisoning varies depending on the dose ingested and how quickly treatment is obtained. Many pets that ingest behavioral health medications can recover, but severe cases can be life-threatening.

With small to moderate doses ingested, signs may resolve in 12 to 24 hours, while larger doses may require up to 3 to 4 days for signs to fully resolve. Pets can often fully recover from ingesting behavioral health medications, although early and appropriate treatment is vital. 

Pet Poison Helpline, an animal poison center based out of Minneapolis, MN, is available 24/7 for pet owners and veterinary professionals that require assistance treating a potentially poisoned pet. The staff provides treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals, and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helpline’s per-incident fee includes follow-up consultations for the duration of the poison case. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.